(45) Age, Symptom Management, and Cannabis Use Disorder Risk: A Cross-Sectional Study

Background & Introduction: Cannabis is one of the most used psychoactive substances, with its legalization increasing across the United States. Recent studies show significant demographic variations in cannabis use disorder (CUD) risk, indicating higher prevalence among men, younger adults, and those with lower education or income (1). While appreciable progress has been made in understanding CUD, further research is needed to identify risk factors, including patterns of use. Understanding symptom management through cannabis use and its relationship with CUD risk is crucial, particularly as states continue to legalize medical and non-medical use. This study examines the prevalence and severity of CUD among adults, analyzing consumption behaviors, symptom management, and associated risk factors.

Methods: An anonymous online survey, modified from a survey published in JAMA Network Open, was conducted between June and December 2024 via Facebook, Reddit cannabis communities, and the Pennsylvania’s Medical Marijuana program (2). Of 884 responses, 422 met eligibility criteria. Data included a range of U.S. demographics, usage patterns, symptom management, and concurrent substance use. Participants were categorized as CUD unlikely and likely based upon the DSM-5 criteria (3). Analysis used Pearson's Chi-square, Fisher’s exact test, and linear regression analysis (4). The Geisinger Institutional Review Board approved the study, including the survey questions, flyers, and information for distribution.

Results: The overall prevalence of CUD was 53.8% (28.7% mild, 13.5% moderate, and 11.6% severe). While both groups predominantly combined both medical and non-medical use, significant usage patterns emerged (p=0.028). CUD likely individuals reported higher non-medical use (9.2% CUD Unlikely vs. 15.9% CUD Likely) while CUD unlikely individuals reported higher medical use (34.4% CUD Unlikely vs. 24.7% CUD Likely). Age emerged as a significant factor independent of other substance use. Among cannabis-only users (n=262, p=0.0004), younger adults showed higher CUD risk, with CUD likely users concentrated in ages 18-35 (36.8% CUD Likely) compared to CUD unlikely users (17.5% CUD Unlikely). Polysubstance use further increased CUD risk (p < 0.0001) with CUD likely individuals showing higher rates of e-cigarette (14.5% CUD Unlikely vs. 26.3% CUD Likely), smoking (14.1% CUD Unlikely vs. 19.8% CUD Likely), oral tobacco use (3.1% CUD Unlikely vs. 14.3% CUD Likely), and excessive alcohol consumption (4.6% CUD Unlikely vs. 18.9% CUD Likely). Additionally, a strong correlation existed between CUD and the number of other substances used (R2=0.967). Among the symptoms managed with cannabis, mental health symptoms were prominent in CUD likely individuals, particularly for anxiety (64.1% CUD Unlikely vs. 72.6% CUD Likely), stress (65.1% CUD Unlikely vs. 71.2% CUD Likely), and depression (44.6% CUD Unlikely vs. 64.6% CUD Likely). Physical symptom management also differed, with CUD likely individuals reporting more nausea or vomiting (27.8% CUD Unlikely vs. 43.4% CUD Likely) and appetite (26.2% CUD Unlikely vs. 35.8% CUD Likely). Consumption methods varied with dabbing (16.3% CUD Unlikely vs. 26.9% CUD Likely), smoking (60.0% CUD Unlikely vs. 73.1% CUD Likely), and drinking (15.8% CUD Unlikely vs. 24.1% CUD Likely), which were more common among those meeting CUD criteria.

Conclusion & Discussion: These findings demonstrate that younger age is a significant risk factor for CUD, independent of polysubstance use. The strong association persists even among cannabis-only users, suggesting age related vulnerability extends beyond the use of other substances. Compounding effects of other substances further increases CUD risk, particularly among young users. Mental health symptoms were particularly prominent among CUD likely individuals. Our findings emphasize the need for developing age-specific interventions and a comprehensive screening approach, particularly for young adults managing mental health symptoms through cannabis use.

References: 1) Hasin DS, Shmulewitz D, Sarvet AL. Time trends in US cannabis use and cannabis use disorders overall and by sociodemographic subgroups: a narrative review and new findings. Am J Drug Alcohol Abuse. 2019;45(6):623-643. doi: 10.1080/00952990.2019.1569668. Epub 2019 Mar 14. PMID: 30870044; PMCID: PMC6745010.

2) Lapham GT, Matson TE, Bobb JF, et al. Prevalence of Cannabis Use Disorder and Reasons for Use Among Adults in a US State Where Recreational Cannabis Use Is Legal. JAMA Netw Open. 2023;6(8):e2328934.doi:10.1001/jamanetworkopen.2023.28934

3) Patel J, Marwaha R. Cannabis Use Disorder. [Updated 2024 Mar 20]. In:StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538131/

4) Kim HY. Statistical notes for clinical researchers: Chi-squared test and Fisher's exact test. Restor Dent Endod. 2017 May;42(2):152-155. doi: 10.5395/rde.2017.42.2.152. Epub 2017 Mar 30. PMID: 28503482; PMCID: PMC5426219.